J Cardiol 2004 Dec; 446: 243 250 1 Ampulla Cardiomyopathy With Left Ventricular Apical Mural Thrombi Resolved by Anticoagulant Therapy Without Systemic Complication: A Case Report Akira Hiroshi Takatoshi Takahiro Masayuki Takeo Hitoshi Masunori TAKAKI, MD OGAWA, MD WAKEYAMA, MD IWAMI, MD KIMURA, MD TANAKA, MD UCHINOUMI, MD MATSUZAKI, MD, FJCC Abstract A 79-year-old woman was admitted for treatment of bronchial asthma. ST-segment elevation in the precordial leads 4 6 and T-wave inversion in leads,, and af was recognized. Transthoracic echocardiography and emergent cardiac catheterization demonstrated two large mobile thrombi1.2 1.3 cm, 0.71.0 cmattached to the left ventricular wall. There was no organic stenosis. Left ventriculography revealed anterolateral, apical and inferior dyskinesis, and basal hyperkinesis. The clinical diagnosis was ampulla cardiomyopathy. Anticoagulant therapy was started. Prothrombin time-international normalized ratio was remained at 2.53 and partial thromboplastin time was controlled at 1.52 times compared with the normal value. Repeated echocardiography showed the mass reduced gradually and had disappeared about 2 weeks later. J Cardiol 2004 Dec ; 446: 243250 Key Words Cardiomyopathies, other ampulla Echocardiography, transthoracic Anticoagulants Thrombosis left ventricular apical mural thrombi 1 2 2 : 7458522 11; Division of Cardiology, Tokuyama Central Hospital, Yamaguchi; Division of Cardiovascular Medicine, Department of Medical Bioregulation, Yamaguchi University School of Medicine, Yamaguchi Address for correspondence : TAKAKI A, MD, Division of Cardiology, Tokuyama Central Hospital, Koda-cho 11, Shunan, Yamaguchi 7458522; E-mail: atakaki@msf.biglobe.ne.jp Manuscript received January 28, 2004 ; revised March 23 and April 26, 2004 ; accepted May 27, 2004 243
244 Fig. 1 Serial electrocardiograms demonstrating changes in the ST segment and T wave A: On admission. B : After 7 days. C: After 28 days. 79 : : 2003 9 400mg/day 450 mg/day 10 11 11 13 300mg : C : 156 cm40 kg36.8c 130/78mmHg98/min Fig. 1A: Fig. 2 Chest radiograph 98/minaF T 4 6 ST X Fig. 2: 53% J Cardiol 2004 Dec; 446: 243 250
245 Table 1: : 21.21.3cm0.71.0cm Fig. 3 Figs. 4AB Figs. 4CD 5 mmhg 2 mmhg4.82 l/min Table 1Laboratory findings on admission WBC 7,710/l RBC 38310 4 /l Hb 12.2 g/dl Ht 36.80% Plt 26.510 4 /l TP 6.8 g/dl GOT 35 IU/l GPT 13 IU/l LDH 267 IU/l CRP 0.35 mg/dl BUN 15.0 mg/dl Cr 0.56 mg/dl Na/Cl 137/99 meq/l K 3.7 meq/l HbA 1C 4.90% Troponine 1.19 ng/ml Myoglobin 47 ng/ml CK-MB 5.1 ng/ml ANP 43.3 pg/ml BNP 548.2 pg/ml Adrenaline 0.01 ng/ml Noradrenaline 0.17 ng/ml Dopamine 0.01 ng/ml 3 mg/day 10 4 U/day PT-INR2310% 1.52 600mg/day 250 mg/day 450 mg/day 257 5 0.40.4 cm 0.81.2 cm 12 26 cm/sec7 1 0.6 1.0 cm Fig. 3 14 Fig. 3 D- Table 2 metaiodobenzylguanidine H/M 1.65 36.4% Fig. 528 Fig. 6 4 6 T Fig. 3 Transthoracic echocardiograms showing thrombi in the left ventricle Left: On admission : the thrombi were 1.21.3cm and 0.71.0cm. Middle: After 7 days: one thrombus had disappeared and the other was reduced to 0.61.0 cm. Right : After 14 days: remaining thrombus was diminished. J Cardiol 2004 Dec; 446: 243 250
246 Fig. 4 Left and right coronary angiograms, left ventriculograms A: Left coronary angiogram showing no significant stenosis. B: Right coronary angiogram showing no significant stenosis. C, D : Left ventriculograms showing dyskinesis and a contrast defect on the apical wall due to thrombic: Diastole, D : Systole Table 2Levels of PT-INR, T-T and D-dimer PT-INR T-T% On admission 1.03 98 D-dimerg/ml4.1 7th day 2.42 15 3.6 14th day 3.01 9 2.6 28th day 1.12 90 1.0 Anticoagulant therapy was finished on the 28th day, so PT-INR and T-T were normalized. PT-INRprothrombin time-international normalized radio ; T-Tthrombo-test. Fig. 1C58 1990 1 ST 3 J Cardiol 2004 Dec; 446: 243 250
247 Fig. 5 Iodine-123-metaiodobenzylguanidine cardiac scintigrams Defects were seen in the apical, lateral and inferior walls. A : Horizontal long axis. B : Vertical long axis. C: Short axis. D : Bulls eye map. 2 4 34 56 5 Na 43.2 pg/ml Na brain natriuretic peptide : BNP548.2 pg/ml BNP J Cardiol 2004 Dec; 446: 243 250
248 Fig. 6 Left ventriculograms taken 28 days later Normal contraction is shown. Left: Diastole. Right : Systole. 6 BNP 18 BNP 268.8 pg/ml 58 134.7 pg/ml BNP 45 mmhg 4 10 mg/day 7 8 20 2 Vaiktus 9 11 32% 1013 3 9.4% 14,15 1 J Cardiol 2004 Dec; 446: 243 250
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